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All APPLICABLE INFO MUST BEErCOMPLETED FOR APPLICATION TO BE ACCEPTED 1 j I
Date: /• (e Permit Number: / " l' � sf�P
kF
F RECEIVED
Building Permit Application JUL 171016
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
MON
.,,�a.waq��t�.
PROPOSED IN;PRO�VEM.E'Nl" LO:CATION-:
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Address: - - S a 1 '7 Si'LV Eko A K bRi Vt Fo(tr Po'cf2er FL 31 98J_
Legal Description: LO?S 4 g. SO ONit 5 6L-K JL1 -Mob ft /wi VQ? 6CSTMES
Property Tax ID#: 34QQ(,oeoo116nao9 Lot No.
Site Plan Namle: Block No.
Project Name,
Setbacks Front Back: Right Side: Left Side:
®ETAI;LED DE�SCRIPTION -NNW, _UWJWWXtTA%W,O WOR
1
TN s t_t_ 100' O F (o' W o U.J 19 1yAc�/ Fer tLE n NI No g_—NER40
P6P���1
CO:NSTR�U ION IN:FORM -I�N: ,
Additional work to be perform6d performedunder this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /5'004 0 0 Utilities: _Sewer _Septic Building Height:
®INNER/LESSEE: CONTRACO
NamefET7'E� a LL r :.i' Name:
Address' S 1� :151 7 L.V 7 119AK �2i1/� Company:
City: or Pi ti2C E " State: Address: 0Y).
Zip Code:34R$a Fax, City:pQ/CT s1�-/tV7-L(dC1e- Stater
Phone No. J�7ov2�3 SR- 1 F N Zip Code: 3!Z%Y Z/ Fax:
E-Mail: Phone No 7 702 33( -57 34
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
ILIf value of coistruction is 2500 or more,a RECORDED Notice of Commencement is required.
I
IaDE-S
IGNER/ENGINEER' Not Applicable MORTCsAGE COMPANY: Not Applicable
.Name.
Name:
Address: Address:
City.: State: City: State:
Zip: I Phciri Zip: Phone:
i
FEE SII PLE TITLE HOOD R: Not Applicable BONDING COMPANY: Not Applicable
Name: i Name:
Address: l Address:
city: I -_ city:
Zip: I Phort Zip: Phone:
I
OWNER/CONTRACTORFFIDViT:Application is hereby made to obtain a permit to do the work and installation as indicated,
I certify that no work or insto4 tion has-commenced prior to the issuance of a permit.
St.Lucie Coun##yy makes no r6p esentation that is granting a permit will authorize the permit holder to build the,subject structure
which is in tonflict with any lap licable Home Owners Association rules,bylaws or andcovenants that may restrict or prohibit such
structure.Please consult with our Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the gram.) of this requested permit,I do hereby'agree that i wiN;in all respects,perform the work
in accordance with the apprp d plans,the Florida Building Codes and St.Lucie County Amendments,
The following building permilt pplications are exempt from undergoing a full concurrency review:room additions,
accessory sltructures,swimmin pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER 'y ur failure -- Record a Notice of Commencement may result in your paying twice for
improvements to your pr6perEy. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspeetio . if you intend to obtain financing,consult with lender or an attorney before
commencine work or role r ing your Notice of Commencement.
g atur!of Ow er/Lesse6/dontractor as Agent for Owner Slg re of contractor/License Holder
STATE OF FLORIDA STATE OF PLO IDD
COUN OF .:� �.cl~D COUNTY OF �t
The forgoing instrumen was cknowledged before me The for ping instrument was acknowledged before me
this 'lflt�day of 20 by thiday of —,'201 by
( me of person acknowlgEia ng) (Name of person acknowledging)
(Signature of Notary Publ�le'-Mate Of F! ida j (Signature of Notary Public-•Stat of Fi ida)
Persona4 Knowny' io Produced Identification Personally Known ,v-' OR Produced Identification
Type of Identification Type of Identificat-ion
Produced— „ ,°y DEMM Produced
COMMSION B FF 1oeo MY�DEWW
9fF O6rg5
Commission No. oondWaaryPubkU calm ms Commission No. K2018
a � W
REVIEWS FRONT , ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
' DATE ( :,
COMPLETED I
:„. ev.712014
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